What would happen if a new infection emerged in the UK?
In the imaginary town of Chortlington-on-Sea, a man falls ill. Take part in our interactive epidemic scenario and decide for yourself what you would do if you were a public health ofﬁcial or the editor of a local newspaper…
A patient is admitted to Chortlington District Hospital with a high fever and strange red marks on his face. Doctors have seen nothing like it before and order some blood tests.
After a few days the tests return from the hospital labs but have failed to identify an infectious organism. Meanwhile, ﬁve more patients are admitted with similar symptoms. All are put into isolation as a precaution. As a cluster of cases has appeared, the hospital alerts Public Health England.
You are a public health official at Public Health England
News arrives of the outbreak at Chortlington.
(a) Put the message in your pending tray and make a mental note to sort it out later.
(b) Arrange for blood samples to be tested at government laboratories – they should be able to identify the infection.
(c) Ring the Department of Health pointing out there is a strange plague affecting Chortlington.
(d) Go on holiday and hope it goes away.
You are the editor of the local newspaper, the ‘Chortlington Bugle’
Word spreads around Chortlington that people with a strange disease are being quarantined at the hospital. A local anti-immigration group suspects that a recent inﬂux of immigrants has brought a foreign disease to the town. They organise a public meeting and leaﬂeting campaign.
(a) Run a factual account of the outbreak and the public meeting.
(b) Throw your weight behind the campaign – whipping up a bit of controversy is bound to sell a few more papers.
(c) Send your top newshound into the hospital to sniff out a personal interest story from a patient’s family – ‘Builder’s son in face-eating killer bug horror’.
(d) Put the story at the bottom of page 5 as there’s a great picture of the Duchess of Cambridge for the front page.
You are the public health official
Tests come back from the labs, but are still inconclusive. The infection seems to be something entirely new. Meanwhile, ten new cases are diagnosed in Chortlington; two patients are dangerously ill.
(a) Request repeat and more extensive testing – they must have missed something ﬁrst time around.
(b) Contact the Department of Health, passing on all the facts, and organise a local information campaign to calm fears, using press releases and the local radio station, Chortlington FM (“The sunny sound of the seaside”).
(c) Ring Downing Street and insist that COBRA is mobilised immediately and Chortlington evacuated.
(d) Seriously consider the offer of early retirement made last year.
With 30 patients now affected, and ten in intensive care, the situation continues to deteriorate.
(a) Refuse to say anything and run all the tests again – there must be something in there.
(b) Continue to communicate with the local population and engage the help of microbiologists and epidemiologists at the renowned University of Chortlington.
(c) Send a series of panicked emails to the World Health Organization.
(d) Lock the door and refuse to answer the phone till it goes away.
You are the editor
With the latest cases the anti-immigration group has got more vocal, calling for all immigrants to be quarantined then deported straight away. There are rumours they plan to march on the hospital.
(a) Get your newshound to stir things up, making sure your cameraman is there to get some shots of rampage on the streets of Chortlington.
(b) Quietly report the facts but avoid going over the top.
(c) Organise a ‘Quarantine Them Now’ campaign to show solidarity with the local population.
(d) Get a bright junior reporter to do some research on the links between immigrants and outbreaks of disease.
Health Protection Agency researchers and University of Chortlington scientists get together. It turns out that all the people affected walk on Chortlington Downs, next to the sea. Ecologists studying the Downs suggest a species of biting insect newly seen on the Downs, possibly because of global warming, might be involved. Your ace reporter comes back to tell you that there is little evidence that immigrants ever bring in infections.
(a) Send the reporter away to make something up anyway.
(b) Poke fun at the authorities for catching butterﬂies in the midst of a serious epidemic.
(c) Attack the government for cutting support for environmental science when it’s obviously essential.
(d) Reuse the picture of the Duchess of Cambridge.
Further research reveals a bacterium normally seen only in the Chortlington tree-creeper is present in the patient blood samples. A breakthrough: the insect contains the bacterium in its gut. And, surprisingly, the bacterium infects human cells in culture.
Things fall into place: the bacterium has mutated so it can infect humans; the new vector is transmitting it between the reservoir and people. An experimental drug is given to the patients, all of whom recover.
And the reality is...
In fact, genuinely new infections are extremely rare in the UK. If a local or regional diagnostic service were unable to identify an infectious agent, it would be referred to the Rare and Imported Pathogens Laboratory (RIPL) at Porton Down, which can diagnose unusual and imported infections.
All clusters of infections are automatically reported through NHS systems. Any unusual clusters might be a sign of a new epidemic, or possibly even bioterrorist activity. If the cluster were not brought under control, the problem would be escalated to the Department of Health and other government departments. The highest level alert would involve COBRA (Cabinet Ofﬁce Brieﬁng Room A), which coordinates responses to national emergencies. COBRA meets rarely, but did so in response to the outbreak of H5N1 in an East Anglian chicken factory in 2007 and the threat of Ebola in October 2014.
In a serious outbreak or pandemic the government would decide on steps to safeguard public health, such as closing schools, postponing major public events or imposing quarantine restrictions. One role of COBRA would be to coordinate the public health response, such as vaccination or drug treatment programmes. Periodic exercises simulate the impact of an outbreak, check preparedness and improve emergency plans.Lead image:
Illustration © Glen McBeth